Prescription ·Strong evidence ·Reviewed May 2026
Enalapril is an ACE inhibitor prodrug with landmark evidence from the SOLVD trial demonstrating mortality reduction in heart failure with reduced ejection fraction. It is widely used for hypertension, heart failure, and asymptomatic left ventricular dysfunction.
The bottom line
Evidence rating strong. Most-documented uses: reduces mortality in heart failure with reduced ejection fraction, lowers blood pressure effectively, prevents cardiac remodeling after mi. 10 sources indexed (1985–2023), with 7 interaction records on file.
Core mechanism
Prodrug hydrolyzed in the liver to enalaprilat, the active ACE inhibitor. Enalaprilat inhibits angiotensin-converting enzyme, blocking the conversion of angiotensin I to angiotensin II. This reduces peripheral vascular resistance, aldosterone secretion, and cardiac remodeling. Also inhibits bradykinin degradation.2
Can be taken with or without food; prodrug requires hepatic conversion to active enalaprilat4
Nutrients this medication can lower over time, and what to replace.
ACE inhibition has been associated with increased urinary zinc excretion and altered taste in some long-term users.
Enalapril reduces aldosterone, decreasing potassium excretion. Potassium supplements significantly increase hyperkalemia risk.
Recommendation: Avoid potassium supplements on enalapril unless prescribed with monitoring. Avoid potassium salt substitutes.
Enalapril reduces sodium reabsorption and lowers glomerular filtration, which causes the kidney to retain lithium and pushes serum lithium levels up. In prescription-lithium patients started on enalapril, lithium concentrations have risen by roughly a third within weeks. Lithium Orotate doses are much smaller, but the same handling principle applies and the margin between therapeutic and toxic lithium is narrow; older adults, dehydrated patients, and those on diuretics or NSAIDs are most at risk.
Recommendation: Avoid Lithium Orotate while taking enalapril. If you must use it, keep the dose low, stay well hydrated, and ask your prescriber to check a serum lithium level after a week or two. Hold lithium during any vomiting, diarrhea, or fever illness.
Enalapril increases urinary zinc excretion and lowers intracellular zinc in monocytes over months of use. In a 6-month controlled study of hypertensive patients on captopril or enalapril, intramonocyte zinc fell significantly in both groups, supporting a class effect on zinc status. Symptoms of zinc deficiency include altered taste, slow wound healing, hair loss, and reduced immune function.
Recommendation: If you take enalapril long term, consider a modest zinc supplement (15-30 mg/day) or a multivitamin containing zinc, especially if you notice loss of taste or recurrent infections. Take zinc with food to limit GI upset, and have your prescriber check zinc status if you suspect deficiency.
Enalapril increases urinary zinc excretion and lowers intracellular zinc over months of use. Zinc Picolinate is a well-absorbed form often used to correct this kind of subclinical deficiency. Symptoms of zinc deficiency include altered taste, slow wound healing, hair loss, and reduced immune function.
Recommendation: If you take enalapril long term, consider Zinc Picolinate 15-30 mg/day with food, especially if you have altered taste or recurrent infections. Have your prescriber check zinc status if you suspect deficiency rather than dosing higher empirically.
Coenzyme Q10 lowers blood pressure modestly through improved endothelial function and reduced oxidative stress. A clinical study using CoQ10 as a component of combination therapy with enalapril found improved 24-hour blood pressure control and better endothelial function compared with enalapril alone. The combination is generally additive and well tolerated.
Recommendation: If your blood pressure is well controlled on enalapril alone, monitor at home before adding CoQ10. A typical dose is 100-200 mg/day with a fat-containing meal. Recheck blood pressure within 2-4 weeks and tell your prescriber so any enalapril dose adjustment can be made.
Garlic Extract lowers blood pressure modestly and has independent ACE-inhibitory activity in vitro. When combined with enalapril the effects are additive, which is helpful in uncontrolled hypertension but can produce mild hypotension if blood pressure is already at goal.
Recommendation: If your blood pressure is already well controlled on enalapril, monitor at home before and after starting Garlic Extract. Typical aged garlic doses are 600-1200 mg/day. Tell your prescriber so your enalapril dose can be adjusted if needed.
Quercetin lowers blood pressure modestly (about 5-7 mm Hg systolic in stage 1 hypertensives) through endothelial improvement, AT1 receptor downregulation, and natriuresis. Combined with enalapril the effects are additive and generally well tolerated, though mild hypotension is possible if blood pressure is already at goal.
Recommendation: Quercetin 500 mg twice daily is a typical research dose; monitor home blood pressure after starting and tell your prescriber so your enalapril dose can be reviewed. Take with food to limit GI upset.
Numbered references. Citations throughout the page link here.
Reyaz I, Kaur A, Saad MZ et al.. Comparison of Outcomes Between Sacubitril/Valsartan and Enalapril in Patients With Heart Failure: A Systematic Review and Meta-Analysis. Cureus. 2023
Faisal M, Cawello W, Laeer S et al.. Clinical Pharmacokinetics of Enalapril and Enalaprilat in Pediatric Patients-A Systematic Review. Frontiers in pediatrics. 2021
Zhang Y, Liu J, Li Y et al.. Protective Role of Enalapril in Anthracycline-Induced Cardiotoxicity: A Systematic Review. Frontiers in pharmacology. 2020
Rizzoni D. Fixed-dose lercanidipine and enalapril in field practice: a meta-analysis. Current medical research and opinion. 2016
He YM, Feng L, Huo DM et al.. Enalapril versus losartan for adults with chronic kidney disease: a systematic review and meta-analysis. Nephrology (Carlton, Vic.). 2013
Moncloa F, Sromovsky JA, Walker JF et al.. Enalapril in hypertension and congestive heart failure. Overall review of efficacy and safety. Drugs. 1985
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